Reactivation of Old Scars in an Elderly Man Revealing L？fgren's Syndrome

Here, we report the case of a 55-year-old man with reactivation of old cutaneous scars associated with a febrile illness, episcleritis, polyarthralgias, erythema nodosum and hilar adenopathy. High-resolution computed tomography (HRCT) revealed right paratracheal, bilateral hilar, and subcarinal lymphadenopathy without any nodular densities in both lung fields. A scar biopsy revealed multiple noncaseating granulomas and confirmed the diagnosis of sarcoidosis. A short course of oral steroids led to regression of systemic symptoms, and the scars returned to baseline size. This patient represented a rare case of simultaneous L？fgren’s syndrome and scar sarcoidosis. 1. Introduction Sarcoidosis is a multisystem granulomatous disease of unknown cause. The diagnosis usually requires a compatible clinical picture, histologic demonstration of noncaseating granulomas, and exclusion of other diseases capable of producing similar histology or clinical features [1]. Systemic ？symptoms？ such？ as ？fatigue,？ night？ sweats,？ and ？weight？ loss are ？common;？ the？ organ ？system ？that ？is？ most ？affected？ varies？ with？ the ？given ？patient [2]. The differential diagnosis of skin lesions in a patient with acute febrile illness and joint pains and hilar lymphadenopathy is extensive. We report a case of L？fgren’s syndrome associated with scar sarcoidosis. 2. Case Presentation A 55-year-old man presented to our hospital with 6-week history of low-grade intermittent fever, malaise, fatigue, joint pains involving both knees and ankles along with painful nodules on left lower limb, and redness of both eyes of 1-week duration. He had loss of appetite and a weight loss of 3？kg over this period. He complained of increasing size of old scars present on his forehead (Figure 1). These scars occurred following a road traffic accident 10？years ago. He denies any pruritus or pain in scars. There was no history of breathlessness, chest pain, or night sweats. Figure 1: ？ Scar enlarged on the forehead. Physical examination revealed the following: pulse rate—84/minute, blood pressure—120/80？mm？Hg, and respiratory rate—18/minute. The lesions on the forehead were subcutaneous, firm, nontender, and minimally mobile, and he also tender subcutaneous nodules on left shin suggestive of erythema nodosum. Eye examination revealed bilateral episcleritis. He had tenderness in both knees and ankles without any swelling. There were no lymph nodes or hepatosplenomegaly. Chest and cardiac examination was unremarkable. Laboratory investigations showed the following: hemoglobin 14.0？Gm%, TLC of 10800 with 70%